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  1. #1
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    Default IDPH, the EMT Tests, and the National Registry

    So, in another thread, Art talks about this:

    Our "friends" at IDPH have decided, apparently without any legislative oversight, that the EMT-B, I, and P tests are either corrupted, compromised or otherwise unreliable, and that all students currently enrolled (and, by the way, ABOUT TO GRADUATE IMMANENTLY) must take the National Registry for certification. Art said this:

    Just recently, Don Moffitt got the call from Springfield that the DPH was attempting to require national certification for all EMTs in the state by disguising it as an emergency, thereby side stepping the hearing process, and Moffitt was in his car and in Springfield and BLOCKED it.
    Which is partially true. Art, our EMS System Coordinator couldnít say enough good things about Don and his actions during this contentious meeting. She advised me that the room was packed: system coordinators from across the state, Leslie Stien-Spencer (EMS Coord for the state) and all of the State regional coordinators. Even, obviously, our state reps who are as concerned about this as anybody. But, the one who pulls the strings, specifically, Dr. Eric Whitaker, Director for IDPH, was ABSENT from this very critical meeting. Don spoke to the room about the late nature of this move, itís back-room qualities, and the timing. Everyone left the room feeling that this crisis had been averted.

    Today, I received this email from our EMS System:

    EMS Chiefs and Coordinators---
    >
    > Received word today that effective immediately, there is no State of Illinois test available for any level (B,I, or P). This means that our current EMT-P and EMT-B class have no State test for licensure. They may opt to take the National Registry exam; however, the availability (and MANY other issues) are a problem with this option.
    > This follows many weeks of discussion regarding the integrity of the State tests and how to resolve this issue. Do not know what the next step is, but suggest if you are concerned about this and the process that has been used to come to this State-wide decision that you call your State Officials--- State Senator of 35th district Brad Burzynski (895-6318) or State Representative Bob Pritchard (748-3494).
    > Thank you for consideration of this crisis.
    Now, let me say that I do not have a problem with the National Registry. Itís a very good program and youíd better know your poop to get it. And thereís nothing wrong with knowing your poop. HOWEVER, there are a couple of problems:

    #1: The cost. Weíve already laid out $2,400 for tuition. We are LUCKY in that weíve had no salary costs (which could EASILY top $15,000 for a 3 semester course). NOW, itís going to cost us $220 for an exam fee (versus the states $40) (times 2 for both students).
    #2: And by far the biggest problem: availability. There are exactly TWO exam sites in this state FOR THE REST OF THIS CALENDAR YEAR. One in Quincy on August 13 (too soon, medic class doesnít finish until August 20) and one in Maywood on November 24.

    - - - - - -
    So far, Iíve been crying about paramedic testing. Thatís cause thatís where WE are the shortest. Iím gonna miss out on Joshís shindig this weekend because Iím on call and canít get the others to cover (oddly enough, they have lives too). I know that others on my department have missed out on things because of the availability of paramedics to cover the rig. Weíve got two people in medic class now, set to graduate and two more bodies would make one hell of a big difference in our schedule. But how about these other departments that run a BLS rig? They are undoubtedly in the same fix we are.

    Iím calling and emailing my legislators, but is it too late?
    Last edited by jaybird210; 07-07-2004 at 11:57 AM.

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    Jay:
    I have Don's phone in the house chamber. I will call him and find out what's going on with this.
    He thought that he had stopped it in its tracks, but apparently, it has re-surfaced.
    I have no problem with the National Registry. I took it when I was an EMT, but something isn't right here. All of a sudden, the state test isn't sufficient? Or has been compromised? Or has too high of a pass/fail rate? Or somebody wants to make more money off of the higher fees?
    Don't know the reason, but I intend to find out.
    It is my opinion that if there is a state agency that is a loose cannon, it would be the IDPH.
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    Wow....are they TRYING to scare people off from advancing from EMT-B to P???? i don't know about the rest of the state, but down here we have plenty of B's, but every week there are ads and ads in the papers for paramedics! There's a shortage!!
    First, they get rid of the EMT-I program. no more of them at all
    THEN, they make the EMT-P program 2 1/2 years instead of 1 year of schooling.
    NOW, they are making you take the national registry??? Hmm....and people wonder why I am only a basic...I was seriously starting to think about doing P to get a full time job doing such, but now i'm not so sure....I'm with you on writing the legislators! I'm gonna make a draft right now...
    Last edited by lauraboczek; 07-07-2004 at 12:53 PM.
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    Jay:
    I got off of the phone with SR Moffitt. He was going to contact IDPH and discuss these latest developments.
    It ain't over till it's over. He understands the ramifications of all that we discussed.
    I believe that, until Dr. Whitaker can get new state testing in place, that he leaves the old test in place until such time. Or at the very least, put a temporary testing process in place until a new state test can be formulated. And behind door number three, update the old test.
    But to require National registry along with the additional fees is just plain wrong.
    Stay tuned.
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    Thumbs down

    Sorry to butt in but I figured I would give my thoughts.


    It sounds like you guys are in the same boat as Ohio a long time ago. Ohio just went from one day having a state test then the next you had the Nat'l Registry. I beleive that the NREMT is a great big SCAM!!!!!!! Because if it was true to its words I could walk in to any state show my cert from them and get handed a Card. But in 90%+ of those states I still have to take their state test. All that they want is the $$$ from the test applications.


    An example: I just took my medic test I had a 83% overall score. BUT I got 2 more questions wrong a section than I was allowed......I failed it!!!! Now I have to pay them $50 again to take the test and drive 2 hrs away.


    Sorry for my interruption....good luck with keeping your state test.
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    Laura;
    Not trying to scare you off, but some additional info for ya:

    The EMT-I program is not gone. A little background: The curricula for all three levels is set by the FEDs (DOT believe it or not). The curricula for these levels has been changing, in fact, increasing by leaps and bounds in the last couple of years. The latest change in both I and P has increased the hours exponentially. There is now, I believe, less than 200 hours difference between I and P. Hardly worth going I. Consequently, nobody is offering an I class anymore. Probably a good thing. After doing this thing for almost 15 years now, I think that B's should be trained to do what I's can do, and just have 2 levels. But the PMDs get anxious about Basics intubating.

    Why is this going on? Thank the health care field in general. Because of the spread of home health care, the insurance companies and heaalth care industries have discovered that it is cheaper to have paramedics do things than nurses, PAs, or doctors. Now the medic curriculum includes insertion and maintenance of foley catheters, suturing, NG tubes and other stuff that really outta be done in a hospital (IMO).

    So actually, you got two complaints there.

    P.S. 7134, butt in anytime. Actually, I think that is pertinent info....

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    As I told Mr. Moffitt today, I believe that it's all about MONEY!
    And in a time when we can ill afford to lose more volunteer ambulance services, this will be the impact felt by this latest decision.
    In my mind, I would want paramedic level care should I need it. I can think of many instances where that would be a benefit.
    But let's face it; if we have paramedics doing EVERYTHING, then it will drive up the cost for EVERYTHING.
    EMT-Bs and Ds have a purpose and I don't think the National registry should be the benchmark for what I think is a very good state EMT program.
    I will say it again; it's not about quality of care. It's about MONEY.
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    Me thinks this stems from a recent "scandal" involving CFD EMT-B's and the State test. We need to keep pressure on the IDPH. Not only on this issue, but also to keep becoming an EMT-P from turning into a two year ordeal (and thats not even counting EMT-B school)
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    MIKEY-

    My information supports your conclusion.

    Got this memo this morning:

    TO: EMS Medical Directors
    EMS System Coordinators
    Lead Instructors

    FROM: Leslee Stein-Spencer, R.N., M.S.
    Chief, Division of Emergency Medical
    Services and Highway Safety

    DATE: July 8, 2004

    SUBJECT: EMT State Exams

    As you know, the Illinois Department of Public Health (IDPH) has been considering implementation of the National Registry examination for EMTs. After listening to concerns expressed at the Emergency Medical Services (EMS) Advisory Council meeting in June and after numerous discussions with individuals throughout the EMS community, the Department has decided not to require the National Registry exam, but instead to revamp the state EMT examination. Of course, this will require time and the assistance of the EMS community to develop a data bank of test questions.

    In the interim, since the Department currently does not have a viable state examination, EMT students will be offered the option of either taking the National Registry exam or waiting until the state examination is available. For those students who wish to take the National Registry exam, please contact your Regional EMS Coordinator for scheduling.

    We are assembling the education sub-committee of the EMS Advisory Council to immediately begin work on creating the data bank questions so the state examination can again be offered. This issue is of great importance to the Department, and we ask your patience as we create an examination that fairly tests the stateís EMT candidates and ensures the best possible care for the citizens of Illinois.

    If you have questions or concerns, please feel free to contact me at 312/814-5171 or 217/785-2080.

    LSS/wjc
    Cc: Quin Golden, IDPH, Chief of Staff
    Catherine M. Stokes, IDPH, Deputy Director, Emergency Preparedness
    Anne Murphy, IDPH, Chief Legal Counsel
    So, this tells me that the state is going to keep their own testing standard in place, but couldn't get their act together in time to test those folks currently in class. Their "solution" is to force these poor folks to either wait till IDPH has their act together (they couldn't get this done in 7 months. How long does it take to create a series of tests?) or take the National Registry.

    I say, BS; there is no effort on the part of IDPH to implement a test at any level. They know that any test they produce has the chance of being obtained by someone outside the agency and thereby comprimising the integrity of the tests, so let's just let the National Registry handle it. I would now refer you to the post from our brother from Ohio. Once the NR comes in, do they ever get out? Kinda like a contract.... oh, oops, won't go there (THAT'S A JOKE!!).

    Anyway this whole thing stinks. Please call your states reps and senators and tell them what you think of this plan.

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    ALSO.....

    The medic class going to 2 years is not really the fault of IDPH. That is the Fed DOT changing the curriculum to satisfy the health care industry to expand the scope of paramedics in the field. I am not going to comment on whether this is a good thing or a bad thing. I think it depends on where you live. If you live in Montana and the nearest hospital is three hours away, and you can have the local paramedic come and re-insert your foley, then it's probably a good thing.

    Does it make sense for a medic in Aurora (particularly a FIRE-medic) to be tied up for a half hour or more on the same deal? Or Streamwood or DeKalb or Country Club Hills or Richton Park? My concern is for these departments who rely on jump-company ambulances as part of their daily contingent, to have those personnel unavailable for firefighting because they have to go and reinsert an NG tube or suture a wound (still can't figure that one out).

    The other issue I have is with the steady and continuous increase in the number of contact hours these classes consist of. I know of one class locally that spent SEVERAL class nights (that is MORE THAN ONE) watching re-runs of Emergency. The instructor's reasoning for this: to demonstrate to the students how far EMS has advanced in 20 years. Bullsh*t. It was filler because you have to have x number of hours for this class. I know this crap goes on, maybe not to this extent, but it still happens, in other classes, at all levels.

    Alright, I'm done ranting now. Gotta go work on fire station plans.

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    Although I realize that there are many States requiring a two year program, I am dead set against it. They just upped it to a year here and I dont even see the benefit in that. Things have changed, but not that much in the 18 years since I started paramedic school. When my Dad went in 1973, it was 108 hours ! I work about 3 miles from a level 1 trauma center and about a mile and a half from another hospital. In Chicagoland,we have many fire department ALS ambulances. We really dont have time to be changing dressings and foleys in peoples houses. If the Feds want to change the primary role of paramedics, then those who would like to change foleys and dressings should be able to do it as a seperate job from the fire department. I for one am not interested. This article also makes me wonder why anyone would want to venture into a career in EMS. Especially in poorer states. Low pay, degree requirement creates shortage of paramedics - Mississippi
    reprint courtesy Hattiesburg American
    Mar 14, 2003, 10:10



    Kristen Almon always wanted to be a paramedic.
    Shortly after the Lamar County native graduated from high school in 1994, she went through certification to become a basic emergency medical technician and got a job working as an EMT for a hospital.

    "I had my career mapped out - I was going to be a basic for a year or so and then go to school and become a paramedic," she said. "Within that year I got married, had my first child and had to leave the field because the pay was so poor. I made just over minimum wage and I was working over 40 hours a week. There was no way I could help support my family that way."

    Almon is not alone, said Beverly Courtney, director of operations for A Superior Ambulance Provider in Laurel.

    "There is a shortage of paramedics in Mississippi and pay is probably one of the biggest reasons - not only here, but across the nation," she said.

    Low pay, along with the curriculum change that made the paramedic program a two-year associates degree program instead of a one-year technical program has hurt the field, said Courtney, whose company is short two EMTs.

    "Several would-be paramedics are becoming registered nurses or other health care professionals because the same amount of schooling is required and the pay is better," she said.

    Wade Spruill, chief operating officer for AAA Ambulance Service in Hattiesburg, said his company spent more than $250,000 last year on pay raises for its employees.

    "We underwent a massive restructuring," he said. "We decided to develop a pay range for each level of our employees, from dispatchers to flight medics.

    "Each field now has a career path that was established to boost morale and increase pay based on experience in an effort to keep our employees with us."

    Spruill said the restructuring and salary adjustments were well worth the money.

    "We have had less than a 7 percent attrition rate since we started the new structure," he said. "We want the experienced people to stay here and want to attract others who want to work for us by looking at our reputation."

    Spruill said his company employs 55 basic EMTs who make an average of $23,000 and 73 paramedics, who average about $31,000. In addition, the company has four full-time Rescue 7 flight paramedics who make about $33,500 each.

    Courtney, whose company employs 32 paramedics and EMTs combined, said the average pay for a starting basic EMT is $20,500 and $28,500 for a starting paramedic.

    According to Bureau of Labor Statistics, the average national earnings for EMTs was $22,460 in 2000, the last year figures were available.

    "The pay for paramedics and EMTs has lagged over the years, " said Jerry Johnston, treasurer of the National Association of Emergency Medical Technicians. "Compared to similar professions, such as in the allied health field or in public safety, EMTs and paramedics are making almost 40 percent less than others who are doing a similar job, unless they are employed by a public safety agency."

    Johnston said there are a variety of factors contributing to the low pay of people in the field of Emergency Medical Services.

    "One big issue is that the reimbursement for the actual service by insurance companies or by other means is low," he said. "It is difficult for employers of paramedics to compensate paramedics when the money is not coming in."

    Spruill and Courtney agreed.

    "The cost of doing business in health care has risen, but the reimbursement is being cut," Spruill said. "The new schedule passed by the federal government last year is giving us less money and is given to us in a four-year phase."

    Courtney said the majority of revenue coming into ambulance companies is from programs such as Medicaid and Medicare.

    "Because the government has made such drastic cuts, we are having to look at other ways to make up for the loss," she said. "We gave our employees a raise last year, but until we find other ways to generate money, we won't be able to raise their salaries any higher. We can't pay them something we don't have."




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    So for now, another catastrophe has been averted, but unless better oversight is given to this agency, this runaway train is going to crash.
    I believe that IDPH has the attention, though unwanted, of the state legislators; one in particular.
    I am certain that developments are going to be closely watched and if IDPH isn't moving forward with some sense of urgency, then I would expect that the state leaders will step in.
    I know that I am going to watch this very closely.
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    Well after spending 9.5 months of my life in medic school...I can say alot of it was a rehash of what I was taught in Basic. And the stuff that I really need to know was barely covered.

    I think that their should be 2 different types of Paramedics and Medic training. A Emergency/FireMedic and a Transport Medic.

    Once I get my medic the likely hood of me messing with someones G-tube is NONE......Not in my local protocol!!! I really give 2 Sh*&S about the lab values from a blood draw. That really doesn't effect me.

    Ohh Well those are my thoughts.

    Congrats on preventing the NREMT Invasion for the moment!! Keep up the fight. Again sorry for the interuption.
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    So for now, another catastrophe has been averted...
    and

    Congrats on preventing the NREMT Invasion for the moment!!
    Not so fast, fellas. Nothing has been changed yet. Students this year, unless something happens double-quick, WILL have to take the NR if they want to get certified right out of class.

    Plus, there's no time frame in that memo. IDPH could get this done by next winter, or spring or fall or summer or 2006 or 2007 or .....? In the meantime, y'all can just keep on taking that NR test....

    I am not resting comfortably yet.

    -------
    On a related note: 7134 mentions what is allowed under local protocol. Very true. That's where this national curriculum is BS. Did you know it is in the national EMT-B curriculum to teach intubation at the basic level? So all EMT-B classes are learning how to intubate. HOWEVER there is not one, single EMS system in this state that will allow basics to intubate. NONE. Why? The PMDs are too nervous about allowing basics to tube. That's their call, but if no one can do it, than it's stupid to be teaching it.

    There is no protocol in our system for NG tubes or foleys or suturing. But all these skills are taught in the class because the feds say, "You WILL use our curriculum." So these classes teach the skills (and waste the students time), but the students will NEVER be allowed to use them. Things are still screwed up.

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    I can't believe that Basics their can't Intubate. Prior to Medic class I had 3 successful tubes as a basic.

    The Basic can only tube unconscious, non-breathing pt. ( Cardiac Arrest). Why in the world should you tie up the medic doing that when the person is DEAD ????? What is the worse that could happen they miss!?! Heck the medic could be starting the IV, putting the monitor on, any number of things. What a waste of education.

    Jay, I understand your frustration with being taught things you cannot use. As a Medic I was taught alot of things that I will never do....but thats what the guys who has never ran on a Ambulance thinks we need to know.

    Good luck with everything.
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    First of all I believe that the State should make all systems allow the EMT B's to perform the same level of care. It's crazy to think that one system could only allow you to do the bare minimum for a patient( Epi Pen, ASA, Albuterol)and a system that sits right next to it allows more( Combi Tube, Atrovent, Nitro, Glucagon, Epi Pen, ASA, Albuterol). If the patients knew about this, which system do you think they would want to be picked up by? Believe me, if I were 15-20 min from the nearest hospital, and 7-10 min from the Paramedics meeting the rig, I want the Basic's with bigger drug box. Working in both systems listed( as a volunteer, and for my job) It's frustrating to know that the unconcious diabetic with a blood sugar of 20 has to wait for the Paramedics because the system does not believe that Glucagon should be used in the B rigs. I think that if this problem is solved, then they can write a test that would be comparable to the NR test.
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    I think that if this problem is solved, then they can write a test that would be comparable to the NR test.


    Give that man a big, fat, see-gar.

    This is my main argument.

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    Thank you.

    The problem is, the Chief won't share his.

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    I totally agree....write a test that is "acceptable" for each state, don't make everybody take the NR, and then like somebody said, when you go to another state, have to take their state's test...makes no sense at all...or here's an idea...if you're going to have the NR, make it an acceptable license for every state! what's the point of the national registry, if when i move to another state and say "oh i'm an NREMT" they say "too bad, take our test too"...oh well...
    when they started teaching b's how to intubate, i was mid-way through class, and my teacher (the wonderful bob swayze, i'm sure some of you know him) came in and said "ok so i get to teach you how to intubate someone....but don't get too excited, because you won't be allowed to do it within the next 20 years if you stay a basic, i guarantee it" and i remember asking him "ummm.....why are we learning it then?" and he said "i don't know...i just teach you what they tell me to". and i hate to admit it, but if i had to intubate someone right now, i'd probably screw it up, because i knew that i couldn't do it, so i never payed too much attention to remembering how...so it was pretty much a waste of my time and everyone else's in the class!!
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    Illinois already has a test that is appropriate for the subject matter. The problem isn't that it isn't an appropriate test; the problem is that the test was compromised. Someone got their hands on the test and shared it. So; what we need to do is to nullify the results for anyone affiliated with the department in question, change up the test a little, make everyone after the date that it was discovered take the new version and everyone should be happy.
    I would be.
    I'm not saying that a periodic review isn't a good idea, but in this case, that is not the reason.
    And in my mind; if anyone is caught cheating, they will have an immediate career change in their future.
    Our state test is fine. It's the other problems that needs fixed.
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    Question

    it is WAY to early here and unless I missed something ....riddle me this Flatlanders..........lets say I am a new Medic prospect in class right now, I opt to take NR as soon as possible since the State tests/testing mechanism is tainted, if I pass the NR test do I still have to then at a later date take a State of IL test to use my skills, or is registry the only one card I will need ? .more on this later from me.....I gotta get some rest.
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    Well, Joshie, those are good questions.

    My understanding is that until IDPH comes up with their own tests, they will accept NR certs and issue an IL cert based on that. Now, prior to this, you still had to take the IL test to get a cert (!?). Basically, the only thing the NR did was let you "klep" out of the IL class. But now, apparently, the NR is good enough (sigh).

    My problems with this whole deal:

    1. The timing is BS. IDPH knew there was a problem with the tests back in January. And nothing positive has been done.

    2. The National Registry is a private organization. There is no governmental oversight. Maybe a good thing, maybe not. But as 7139 pointed out earlier in this thread, the availability of testing sites is a big issue. There are only TWO SITES in Illinois for the rest of this year, one of them is in mid-August when our students are still finishing up class. There has to be at least 1000 EMS students in northern Illinois right now that won't be ready to test in August. Is that one other site gonna handle all of 'em? Not a chance.....

    3. There is great confusion over the fee structure. I have two of my people, plus our EMS system coordinator telling me that the entire fee for the NR tetst is $220 (that's so much for the written and so much for each of the 12 practical stations). Now, one of the state senators that I contacted told me last night that IDPH told him that the total fees for the NR are only $50. So who's right? Of course, now I can't find anything on fees on the NR site (just the $50 written exam fee).

    4. There are no test sites scheduled in Illinois for next year. None. There is ONE scheudled in Inidiana in 2005 (Kokomo, January). There is ONE scheduled in Wisconsin in 2005 (Appleton, May).

    This ain't over yet.

  23. #23
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    This ain't over yet.
    Nor should it be.
    Moffitt is all over this, but he can't seem to get the attention of the head of IDPH. I think that the man is a Blago home boy.
    In any event, I can't help but feel that in the back of my mind, we will see little change in the program, but will see a major change in the fee structure.
    Still got that budget to balance, you know?
    This ain't over yet, by a long shot.
    CR
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  24. #24
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    I think that the man is a Blago home boy.
    Yup.

  25. #25
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    Default And the hits just keep on comin'.....

    Okay, here's some more poop.....:

    1. The fees. Yup, the National Regisrty is a $50 registration fee. BUT, each test site is free to charge whatever they like for the test.

    So, the one in Quincy in August will cost you as follows:

    1. NR Registration fee : $50
    2. Blessing Hospital:
    A. Written test fee: $10
    B. Pratical stations: $20 ea. (there are 8)
    .........................$160
    Subtotal................:$220

    Now, they are also offering a pre-test study course, for only $75 more.
    TOTAL....................$295

    But, those folks in class now can't take this one. They won't have their "T" cards in time. So sign up now for Maywood. And if you miss Maywood in December, you're really ****ed, 'cause there ain't no tests scheduled for Illinois next year (yet). And don't bother signing up out of state. Just found out that the way the IL state law is written, IDPH WILL NOT ACCEPT NATIONAL REGISTRY TEST RESULTS FOR TESTS TAKEN OUTSIDE OF THE STATE OF ILLINOIS.

    It's the energizer bunny.

    I love it here.

    (Edited to fix my rotten math, and spellink)
    Last edited by jaybird210; 07-15-2004 at 12:17 PM.

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